HELIO ELKIS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Meta-analyses of cavum septum pellucidum in mood disorders in comparison with healthy controls or schizophrenia(2018) BERALDI, Gabriel H.; PRADO, Kelly S.; AMANN, Benedikt L.; RADUA, Joaquim; FRIEDMAN, Lee; ELKIS, HelioThe cavum septum pellucidum (CSP) is a neurodevelopmental abnormality significantly more prevalent in subjects with schizophrenia (SCZ) than in healthy controls (HC). Using meta-analyses, we tested the hypotheses whether CSP would be more frequent in subjects with mood disorders when compared with HC or SCZ. We performed a search in MEDLINE and EMBASE followed by 10 meta-analyses of magnetic resonance imaging studies which examined the association of CSP in bipolar disorders (BD), major depressive disorder (MDD) or mood disorders (MD; considering MDD and BD combined) with either HC or SCZ. Nine studies were included, comprising 692 cases (363 with BD, 182 with MDD and 147 with MD), 463 with SCZ and 630 HC. CSP of any size was significantly associated with BD (OR = 2.07, 95% CI: 1.48-2.90) when compared with HC. Large CSP showed a trend to be associated with BD when compared with HC, but the association was not statistically significant (OR = 1.92, 95% CI 0.64-5.78). Large CSP was significantly associated with subjects with SCZ when compared with subjects with MD (OR = 0.57, 95% CI: 0.36-0.92). There was no association between CSP and MDD in comparison to HC or subjects with SCZ. Cortical structures are known to be altered in mood disorders. The present metanalysis found that certain midline brain abnormalities, such as CSP, are also associated with BD. (c) 2018 Published by Elsevier B.V.
- Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis(2020) TURNER, David T.; REIJNDERS, Mirjam; GAAG, Mark van der; KARYOTAKI, Eirini; VALMAGGIA, Lucia R.; MORITZ, Steffen; LECOMTE, Tania; TURKINGTON, Douglas; PENADES, Rafael; ELKIS, Helio; CATHER, Corinne; SHAWYER, Frances; O'CONNOR, Kieron; LI, Zhan-Jiang; BARRETTO, Eliza Martha de Paiva; CUIJPERS, PimBackground Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome. Methods We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics. Results We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (p >0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (p = 0.02). Conclusions IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.
conferenceObject Understanding the impact of persistent symptoms in schizophrenia: cross-sectional findings from the Pattern study(2014) HARO, J.; ALTAMURA, C.; CORRAL, R.; ELKIS, H.; EVANS, J.; MALLA, A.; KREBS, M. O.; ZINK, M.; ALBERTI, L.; BERNASCONI, C.; LALONDE, J.; NORDSTROEM, A. L.conferenceObject CROSS-SECTIONAL FINDINGS FROM THE PATTERN STUDY IN STABLE PATIENTS WITH SCHIZOPHRENIA(2015) ELKIS, Helio; HARO, Josep Maria; ALTAMURA, Carlo; CORRAL, Ricardo; EVANS, Jonathan; MALA, Ashok; KREBS, Marie-Odile; ZINK, Mathias; ALBERTI, Laura; BERNASCONI, Corrado; LALONDE, Justine; NORDSTROEM, Anna-Lena- Understanding the impact of persistent symptoms in schizophrenia: Cross-sectional findings from the Pattern study(2015) HARO, Josep Maria; ALTAMURA, Carlo; CORRAL, Ricardo; ELKIS, Helio; EVANS, Jonathan; MALLA, Ashok; KREBS, Marie-Odile; ZINK, Mathias; BERNASCONI, Corrado; LALONDE, Justine; NORDSTROEM, Anna-LenaBackground: The high societal burden of schizophrenia is largely caused by the persistence of symptoms and accompanying functional impairment. To date, no studies have specifically assessed the course of persistent symptoms or the individual contributions of positive and negative symptoms to patient functioning. The cross-sectional analysis of the Pattern study provides an international perspective of the burden of schizophrenia. Methods: Clinically stable outpatients from 140 study centers across eight countries (Argentina, Brazil, Canada, France, Germany, Italy, Spain and the United Kingdom) were assessed using clinical rating scales: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia (CGI-SCH) Scale and the Personal and Social Performance (PSP) Scale. Additional measures included patient-reported outcomes, patient sociodemographic variables, living situation, employment and resource use. Results: Overall, 1379 patients were assessed and analyzed and had similar sociodemographic characteristics across countries, with 61.6% having persistent positive and/or negative symptoms. Positive and negative symptoms had been persistent for a mean of 9.6 and 8.9 years (SD: 8.8 and 9.6), respectively. Approximately 86% of patients had a functional disability classified as greater than mild. Patients with a higher PANSS Negative Symptom Factor Score were more likely to have a poorer level of functioning. Conclusions: This analysis examines individual contributions of persistent positive and negative symptoms on patient functioning in different countries. A high prevalence of patients with persistent symptoms and functional impairment was a consistent finding across countries. Longitudinal observations are necessary to assess how to improve persistent symptoms of schizophrenia and overall patient functioning.
- Correlation of Health-Related Quality of Life in Clinically Stable Outpatients with Schizophrenia(2019) DOMENECH, Cristina; PASTORE, Adriana; ALTAMURA, A. Carlo; BERNASCONI, Corrado; CORRAL, Ricardo; ELKIS, Helio; EVANS, Jonathan; MALLA, Ashok; MARGARI, Francesco; KREBS, Marie-Odile; NORDSTROEM, Anna-Lena; ZINK, Mathias; HARO, Josep MariaBackground: Generic health-related quality of life (HRQoL) scales are increasingly being used to assess the effects of new treatments in schizophrenia. The objective of this study is to better understand the usefulness of generic and condition specific HRQoL scales in schizophrenia by analyzing their correlates. Methods: Data formed part of the Pattern study, an international observational study among 1379 outpatients with schizophrenia. Patients were evaluated with the Mini International Neuropsychiatric Inventory, the Clinical Global Impression-Schizophrenia (CGI-SCH) Scale and the Positive and Negative Syndrome Scale (PANSS) and reported their HRQoL using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D). The two summary values of the SF-36 (the Mental Component Score and the Physical Component Score, SF-36 MCS and SF-36 PCS) were calculated. Results: Higher PANSS positive dimension ratings were associated with worse HRQoL for the SQLS, EQ-5D VAS, SF-36 MCS, and SF-36 PCS. Higher PANSS negative dimension ratings were associated with worse HRQoL for the EQ-5D VAS, SF-36 MCS, and SF-36 PCS, but not for the SQLS or the EQ-5D tariff. PANSS depression ratings were associated with lower HRQoL in all the scales. There was a high correlation between the HRQoL scales. However, in patients with more severe cognitive/disorganized PANSS symptoms, the SQLS score was relatively higher than the EQ-5D tariff and SF-36 PCS scores. Conclusion: This study has shown substantial agreement between three HRQoL scales, being either generic or condition specific. This supports the use of generic HRQoL measures in schizophrenia.
- An international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels(2023) LEON, J. de; SCHORETSANITIS, G.; SMITH, R. L.; MOLDEN, E.; SOLISMAA, A.; SEPPäLä, N.; KOPEčEK, M.; ŠVANCER, P.; OLMOS, I.; RICCIARDI, C.; IGLESIAS-GARCIA, C.; ORTIZ, B. B.; ELKIS, H.; PALHA, A. J. Pacheco; LLERENA, A.; FERNANDEZ-EGEA, E.; SISKIND, D.; WEIZMAN, A.; MASMOUDI, R.; SAFFIAN, S. Mohd; LEUNG, J. G.; BUCKLEY, P. F.; MARDER, S. R.; CITROME, L.; FREUDENREICH, O.; CORRELL, C. U.; MüLLER, D. J.; IGLESIAS-ALONSO, A.; SPINA, E.; RUAN, C.-J.; WANG, C.-Y.; WANG, G.; TANG, Y.-L.; LIN, S.-K.; LANE, H.-Y.; KIM, Y. S.; KIM, S. H.; RAJKUMAR, A. P.; GONZáLEZ-ESQUIVEL, D. F.; JUNG-COOK, H.; BAPTISTA, T.; ROHDE, C.; NIELSEN, J.; VERDOUX, H.; QUILES, C.; SANZ, E. J.; CUEVAS, C. De las; COHEN, D.; SCHULTE, P. F. J.; ERTUğRUL, A.; YAğCıOğLU, A. E. Anıl; CHOPRA, N.; MCCOLLUM, B.; SHELTON, C.; COTES, R. O.; KAITHI, A. R.; KANE, J. M.; FAROOQ, S.; NG, C. H.; BILBILY, J.; HIEMKE, C.; LóPEZ-JARAMILLO, C.; MCGRANE, I.; LANA, F.; EAP, C. B.; ARROJO-ROMERO, M.; RăDULESCU, F.Ş.; SEIFRITZ, E.; EVERY-PALMER, S.; BOUSMAN, C. A.; BEBAWI, E.; BHATTACHARYA, R.; KELLY, D. L.; OTSUKA, Y.; LAZARY, J.; TORRES, R.; YECORA, A.; MOTUCA, M.; CHAN, S. K. W.; ZOLEZZI, M.; OUANES, S.; BERARDIS, D. De; GROVER, S.; PROCYSHYN, R. M.; ADEBAYO, R. A.; KIRILOCHEV, O. O.; SOLOVIEV, A.; FOUNTOULAKIS, K. N.; WILKOWSKA, A.; CUBAłA, W. J.; AYUB, M.; SILVA, A.; BONELLI, R. M.; VILLAGRáN-MORENO, J. M.; CRESPO-FACORRO, B.; TEMMINGH, H.; DECLOEDT, E.; PEDRO, M. R.; TAKEUCHI, H.; TSUKAHARA, M.; GRüNDER, G.; SAGUD, M.; CELOFIGA, A.; RISTIC, D. IgnjatovicThis is the Spanish translation of an international guideline which proposes improving clozapine package inserts worldwide by using ancestry-based: 1) dosing and 2) titration. Adverse drug reaction (ADR) databases suggest clozapine: 1) is the third most toxic drug in the United States (US), and 2) produces worldwide pneumonia mortality four times greater than that of agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers require the lowest dose and male smokers the highest dose). Poor metabolizer (PM) status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity or inflammation with C-reactive protein (CRP) elevations. People with ancestry from Asia (Pakistan to Japan) or the Americas’ original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/ml. Daily doses of 300-600 mg/day are recommended in the US. Slow personalized titration may prevent early ADRs (including syncope, myocarditis and pneumonia). The core of this guideline consists of six personalized titration schedules for inpatients: 1) Asian/Amerindian ancestry with lower metabolism (in cases of obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) Asian/Amerindian ancestry with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (in cases of obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US of non-Asian/Amerindian ancestry with lower clozapine metabolism (in cases of obesity or valproate) needing 150-300 mg/day, and 6) in the US of non-Asian/Amerindian ancestry with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least 4 weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.
conferenceObject CAN THE POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS) DIFFERENTIATE REFRACTORY FROM NON-REFRACTORY SCHIZOPHRENIA? A FACTOR ANALYTIC INVESTIGATION BASED ON DATA FROM THE PATTERN COHORT STUDY(2018) FREITAS, Rosana de; SANTOS, Bernardo dos; ALTAMURA, Carlo; BERNASCONI, Corrado; CORRAL, Ricardo; EVANS, Jonathan; MALLA, Ashok; KREBS, Marie-Odile; NORDSTROEM, Anna-Lena; ZINK, Mathias; HARO, Josep Maria; ELKIS, HelioconferenceObject Health-related quality of life in outpatients with schizophrenia: what determines changes over time and how to measure them(2017) DOMENECH, C.; ALTAMURA, C.; BERNASCONI, C.; CORRAL, R.; ELKIS, H.; EVANS, J.; MALLA, A.; NORDSTROEM, A.; ZINK, M.; HARO, J.- An International Adult Guideline for Making Clozapine Titration Safer by Using Six Ancestry-Based Personalized Dosing Titrations, CRP, and Clozapine Levels(2022) LEON, Jose de; SCHORETSANITIS, Georgios; SMITH, Robert L.; MOLDEN, Espen; SOLISMAA, Anssi; SEPPALA, Niko; KOPECEK, Miloslav; SVANCER, Patrik; OLMOS, Ismael; RICCIARDI, Carina; IGLESIAS-GARCIA, Celso; MASMOUDI, Rim; SAFFIAN, Shamin Mohd; LEUNG, Jonathan G.; BUCKLEY, Peter F.; MARDER, Stephen R.; CITROME, Leslie; FREUDENREICH, Oliver; CORRELL, Christoph U.; MULLER, Daniel J.; YAGOOGLU, A. Elif Anil; RADULESCU, Flavian S.; CUBALA, Wieslaw J.; IGLESIAS-ALONSO, Ana; SPINA, Edoardo; RUAN, Can-Jun; WANG, Chuan-Yue; WANG, Gang; TANG, Yi-Lang; LIN, Shih-Ku; LANE, Hsien-Yuan; KIM, Yong Sik; KIM, Se Hyun; RAJKUMAR, Anto P.; GONZALEZ-ESQUIVEL, Dinora F.; JUNG-COOK, Helgi; BAPTISTA, Trino; ROHDE, Christopher; NIELSEN, Jimmi; VERDOUX, Helene; QUILES, Clelia; SANZ, Emilio J.; CUEVAS, Carlos De las; COHEN, Dan; SCHULTE, Peter F. J.; ERTUGRUL, Aygun; CHOPRA, Nitin; MCCOLLUM, Betsy; SHELTON, Charles; COTES, Robert O.; KAITHI, Arun R.; KANE, John M.; FAROOQ, Saeed; NG, Chee H.; BILBILY, John; HIEMKE, Christoph; LOPEZ-JARAMILLO, Carlos; MCGRANE, Ian; LANA, Fernando; EAP, Chin B.; ARROJO-ROMERO, Manuel; SEIFRITZ, Erich; EVERY-PALMER, Susanna; BOUSMAN, Chad A.; BEBAWI, Emmanuel; BHATTACHARYA, Rahul; KELLY, Deanna L.; OTSUKA, Yuji; LAZARY, Judit; TORRES, Rafael; YECORA, Agustin; MOTUCA, Mariano; CHAN, Sherry K. W.; ZOLEZZI, Monica; OUANES, Sami; BERARDIS, Domenico De; GROVER, Sandeep; PROCYSHYN, Ric M.; ADEBAYO, Richard A.; KIRILOCHEV, Oleg O.; SOLOVIEV, Andrey; FOUNTOULAKIS, Konstantinos N.; WILKOWSKA, Alina; AYUB, Muhammad; SILVA, Alzira; BONELLI, Raphael M.; VILLAGRAN-MORENO, Jose M.; CRESPO-FACORRO, Benedicto; TEMMINGH, Henk; DECLOEDT, Eric; PEDRO, Maria R.; TAKEUCHI, Hiroyoshi; TSUKAHARA, Masaru; GRUENDER, Gerhard; SAGUD, Marina; CELOFIGA, Andreja; RISTIC, Dragana Ignjatovic; ORTIZ, Bruno B.; ELKIS, Helio; PALHA, Antonio J. Pacheco; LLERENA, Adrian; FERNANDEZ-EGEA, Emilio; SISKIND, Dan; WEIZMAN, AbrahamThis international guideline proposes improving clozapine package inserts worldwide by using ancestry-based dosing and titration. Adverse drug reaction (ADR) databases suggest that clozapine is the third most toxic drug in the United States (US), and it produces four times higher worldwide pneumonia mortality than that by agranulocytosis or myocarditis. For trough steady-state clozapine serum concentrations, the therapeutic reference range is narrow, from 350 to 600 ng/mL with the potential for toxicity and ADRs as concentrations increase. Clozapine is mainly metabolized by CYP1A2 (female non-smokers, the lowest dose; male smokers, the highest dose). Poor metabolizer status through phenotypic conversion is associated with co-prescription of inhibitors (including oral contraceptives and valproate), obesity, or inflammation with C-reactive protein (CRP) elevations. The Asian population (Pakistan to Japan) or the Americas' original inhabitants have lower CYP1A2 activity and require lower clozapine doses to reach concentrations of 350 ng/mL. In the US, daily doses of 300-600 mg/day are recommended. Slow personalized titration may prevent early ADRs (including syncope, myocarditis, and pneumonia). This guideline defines six personalized titration schedules for inpatients: 1) ancestry from Asia or the original people from the Americas with lower metabolism (obesity or valproate) needing minimum therapeutic dosages of 75-150 mg/day, 2) ancestry from Asia or the original people from the Americas with average metabolism needing 175-300 mg/day, 3) European/Western Asian ancestry with lower metabolism (obesity or valproate) needing 100-200 mg/day, 4) European/Western Asian ancestry with average metabolism needing 250-400 mg/day, 5) in the US with ancestries other than from Asia or the original people from the Americas with lower clozapine metabolism (obesity or valproate) needing 150-300 mg/day, and 6) in the US with ancestries other than from Asia or the original people from the Americas with average clozapine metabolism needing 300-600 mg/day. Baseline and weekly CRP monitoring for at least four weeks is required to identify any inflammation, including inflammation secondary to clozapine rapid titration.